Isolation of affect – the dissociation of thoughts and feelings, with the feelings then removed from conscious attention to leave only the thoughts – is closely related to intellectualization. In intellectualization, the uncomfortable feelings associated with a problem are kept out of consciousness by thinking about the problem in cold, abstract, and esoteric terms. First example: I once received a phone call from a junior doctor in psychiatry in which he described a recent in-patient admission as ‘a 47-year old mother of two who attempted to cessate her life as a result of being diagnosed with a metastatic mitotic lesion’. A formulation such as ‘…who tried to kill herself after being told that she is dying of cancer’ would have been much better English, but would also have been all too effective at evoking the full horror of this poor lady’s predicament.

Second example: An ambitious medical student once asked me whether she should take up a career in academic medicine, despite (or so it seemed) having already made up her mind on the matter. I raised some arguments in favour and then some arguments against such a move, in particular that only a very small number of people engaged in medical research ever make a significant discovery. As she did not seem to be taking this argument on board, I asked her to name just one major breakthrough from the past 50 years in the life of a particular top-rated medical research department. Instead of accepting that the department had not made a single major breakthrough in 50 years of publishing one academic paper after another, she resorted to questioning the definition of a breakthrough and then the value of making one.

Third example: After being discharged from hospital, a middle-aged man who had almost died from a heart attack spent several hours a day on his computer researching the various risk factors for cardiovascular disease. He typed out long essays on each of these risk factors, printed them out, and filed them in a large binder with colour-coded dividers. After having done all this, he became preoccupied with the vitamin and mineral contents in various kinds of food, and devised a strict dietary regimen to ensure that he took in the recommended amounts of each and every micronutrient. Despite living on a shoestring budget, he spent several hundred pounds on a high-end steamer on the basis that it could preserve vitamins through the cooking process. Although he expended an inordinate amount of effort, time, and money on his persnickety diet, he did not once consider even so much as cutting back on his far, far more noxious smoking habit.

The focus on abstract notions and trivial footnotes often belies a sort of ‘flight into reason’; the emotionally loaded event or situation is thought of in terms of an interesting problem or puzzle, without any appreciation for its emotional content or personal implications. Instead of coming to terms with the problem, the person may split hairs over definitions; question reasonable assumptions, facts, and arguments; and preoccupy himself with abstruse minutiae. By failing to perceive the bigger picture, he also fails to reach the appropriate conclusion or conclusions, which, as with our medical student or heart attack victim, may hit him very hard come five, ten, or fifty years’ time. Intellectualization can also underlie a number of logical fallacies and rhetorical blind alleys, such as raising irrelevant or trivial counter-arguments, rejecting an argument on the basis of an inaccurate example or exceptional case, using exact numbers for inexact or abstract notions, and ‘blinding with science’. In short, the person appears to be engaging with, and even to be excited by, a certain problem, but without ever truly getting to the bottom of it.

Isolation of affect and intellectualization should be distinguished from plain and simple isolation, which can be thought of as the inverse of intellectualization. Whereas intellectualization involves repressing the emotion but not the thought, isolation involves repressing the thought but not the emotion. The person feels a strong emotion, often breaking down in tears, but is entirely unable to point to its cause. After regaining his composure, he is likely to repress the emotion or its memory until – if he should be so lucky – it returns with a vengeance several years later.